Democrat Karl Dean and Republican Bill Lee faced off Tuesday night in the first of three debates as they compete to become Tennessee's next governor, staying largely cordial as they took on a host of state and local issues.

But the candidates displayed clear differences on everything from Medicaid expansion to education — including how best to support access to pre-K.

Democratic candidate Karl Dean looks at the crowd at the start of the gubernatorial debate at the University of Memphis' Michael D. Rose Theater in Memphis, Tenn., on Tuesday, Oct. 2, 2018. Henry Taylor / The Jackson Sun

Cadets and midshipmen of the Army, Marines, Navy and Air Force ROTC programs at the University of Memphis present the colors before the start of the debate between Tennessee's gubernatorial candidates Democrat Karl Dean and Republican Bill Lee at the University of Memphis' Michael D. Rose Theater in Memphis, Tenn., on Tuesday, Oct. 2, 2018. Joe Rondone/The Commercial Appeal

University of Memphis President M. David Rudd speaks before the start of the debate between Tennessee's gubernatorial candidates Democrat Karl Dean and Republican Bill Lee at the University of Memphis' Michael D. Rose Theater in Memphis, Tenn., on Tuesday, Oct. 2, 2018. Joe Rondone/The Commercial Appeal

Tuesday's debate was the first opportunity for Lee, a Williamson County businessman, and Dean, the former Nashville mayor, to share the stage in a one-on-one format since they became the nominees of their parties.

The hourlong televised debate was sponsored by The Commercial Appeal and the USA TODAY NETWORK - Tennessee, WMC Action News 5, the University of Memphis, the League of Women Voters and the Economic Club of Memphis.

While Dean intermittently highlighted the differences between him and Lee on everything from health care to Second Amendment issues, Lee avoided clashes with his opponent while sharing his vision for the state.

Much of Tuesday's debate focused on the candidates' views on issues facing Memphis and West Tennessee, such as protecting the Memphis Sands Aquifer, attracting jobs to the Memphis Regional Megasite and addressing violent crime.

The statewide issues the candidates tackled included ways to reduce opioid-related overdose deaths and improving education.

Cordial but disagreement from the start

From the start of the debate, the candidates disagreed when asked about what the state should do to address the growing number of Tennesseans lacking access to affordable health insurance.

Dean called the legislature's decision to reject Medicaid expansion under the Affordable Care Act among the worst moves the body has made. He vowed to immediately change that should voters elect him.

"We've lost roughly $4 billion as a result of that decision," Dean said, adding the move has contributed to the struggles of rural hospitals. Throughout the remainder of the debate, Dean returned to the issue of Medicaid expansion.

But Lee took a different approach, saying the health care system in Tennessee and the United States more broadly was flawed and had skyrocketing costs that were unsustainable.

"Expanding a broken, flawed system by taking federal money and moving something down the road that is fundamentally flawed, I believe, is a mistake for Tennessee," he said.

Speaking to reporters after the debate, Dean accused Lee of being evasive on the issue.

"It's easy to say the health care system needs a lot of changes and is complicated," Dean said. "I didn't think the response (from Lee) — there's no substance to it."

Lee told reporters he would fix the health care system by changing the payment method to one that provides incentives for lower costs and by utilizing telemedicine and coordinating care for patients.

"We can lower the costs of health care, but we have to make that a prerequisite to spending money down the road," he said.

Debating how best to improve education

Although Lee and Dean fielded questions during the debate about how to improve underperforming schools and statewide testing, the Democratic nominee said he differed from his opponent, who has previously supported vouchers.

Dean used a question about the state's Achievement School District as an opportunity to criticize Lee.

"I disagree with Mr. Lee strongly on his support and advocacy for vouchers," he said. "I think vouchers actually (move) money out of the public school system and move it into a private school system, and there's no guarantee on the quality of those schools."

Dean's answer was the only time throughout the evening that he was openly critical of Lee.

After Dean touted his support for public education, Lee largely ignored his opponent's criticism, saying that a one-size-fits-all approach to education does not work.

Both candidates seemingly found common ground on revamping the state's education testing system, TNReady, which has experienced multiple flaws, including earlier this year.

Lee called for a "reset" on testing, which he said would involve having a robust conversation with teachers and parents.

Dean said the state needs to change the ways "we think of these tests."

Lee called for changing the vendor of the state's TNReady test. Dean stopped short of such a call.

The candidates also agreed on some aspects related to support for early childhood education. As he has in the past, Dean said he favored universal pre-K. But Lee stopped short of a similar call, saying the state needed to ensure pre-K was effective before expanding it.

Combating the opioid crisis

Lee said addressing the opioid crisis — Tennessee had more than 1,700 overdose deaths last year — was among the top issues the next governor needs to address.

"There is a systemic problem," he said, calling for stiffer penalties for trafficking illegal drugs like fentanyl and heroin. "We have to approach this comprehensively."

Dean said the state needs to have more treatment options for Tennesseans struggling with opioid abuse. But he said because of the state's decision to not expand Medicaid under the Affordable Care Act, Tennessee remains at a disadvantage.

"Tennessee was not ready for this problem," he said.

Protecting women's rights in #MeToo era

Although the audience was cautioned against causing any disruptions during the debate, the crowd briefly erupted with applause and cheers after Dean answered a question about protecting women's rights in the #MeToo era.

"This should be the friendliest and best state and the safest state for women," Dean said.

Dean’s comment came in response to a question about the Supreme Court nomination of Brett Kavanaugh and providing protections for women in Tennessee workplaces.

Lee, who said the Kavanaugh hearings were an example of everything that’s wrong with politics — complete with toxic rhetoric — vowed to protect the dignity of women.

“At the same time, it’s important that we have due process and that we let just processes play out so that the truth be known,” Lee said.

Throughout the debate, the candidates shared aspects of their experiences, with Dean talking about his time as mayor and Lee touting his work as a businessman.

As the debate wrapped up, the candidates once again underlined their differences, with Dean saying his top priority for Tennessee would be Medicaid expansion and Lee saying everything begins with ensuring the state prepares children for success through education.